D447 WGU: Women's and Children's Nursing Latest updated version with expert curated questions and answers

Psychosocial adaptations. Examples of what that is, how it could be applied to a family dynamic, etc.

Definition:

These are the emotional and psychological changes a woman and her family experience during pregnancy and postpartum. (Perry et al., 2023, Ch. 13-14)

Examples:

Acceptance of pregnancy: Early ambivalence → excitement or anxiety as reality sets in.

Body image adjustment: Responds to body changes.

Reordering relationships: Partner often experiences "couvade syndrome" (sympathetic pregnancy symptoms).

Attachment process: Mother-infant bonding begins before birth (talking to fetus, imagining baby traits).

Nursing application to family dynamic:

Encourage partner involvement, attend prenatal visits together.

Assess for maladaptation (e.g., detachment, denial).

Offer supportive listening, community resources, and counseling referrals if persistent anxiety or depression occur.

Epiglottitis! Major signs/symptoms, priority interventions, signs of further demise, appropriate medications, etc!

Pathophysiology:

Severe inflammation of the epiglottis, often caused by Haemophilus influenzae type B (Hib). It's a life-threatening emergency due to airway obstruction. (Perry et al., Ch. 41)

Major Signs/Symptoms:

Sudden high fever

Severe sore throat, dysphagia, drooling

Muffled voice, "tripod" position

Inspiratory stridor, retractions

Anxiety, restlessness

NO cough (different from croup!)

Priority Interventions:

Do NOT inspect or swab throat. → Can precipitate complete airway closure.

Airway first! Keep emergency tracheostomy/intubation set by bedside.

Provide humidified oxygen.

NPO status until airway secure.

IV antibiotics (3rd gen cephalosporins, e.g., ceftriaxone).

Corticosteroids may reduce inflammation.

Signs of worsening:

Increasing stridor

Decreased level of consciousness

Cyanosis

Prevention:

Routine Hib vaccination in infancy.

Postpartum hemorrhage! Major signs/symptoms, priority interventions, signs of further demise, appropriate medications, etc!

Definition:

Blood loss ≥ 500 mL after vaginal birth or ≥ 1000 mL after cesarean, or any amount causing hemodynamic instability. (Perry et al., Ch. 36)

Four "T" Causes:

Tone: Uterine atony - most common.

Tissue: Retained placenta fragments.

Trauma: Lacerations or hematomas.

Thrombin: Coagulopathies.

Risk Factors:

Prolonged or rapid labor

Overdistended uterus (multiples, polyhydramnios)

Use of magnesium sulfate

Induced/augmented labor

Chorioamnionitis

Placenta previa or accreta

Prior history of PPH

Major Signs/Symptoms:

Boggy uterus (soft, noncontracting)

Excessive bright red bleeding

Tachycardia, hypotension

Pale, clammy skin

Decreased urine output

Priority Interventions:

Massage fundus firmly.

If not firm → Administer uterotonics:

Oxytocin (Pitocin): IV/IM

Methylergonovine (Methergine) - contraindicated with hypertension

Carboprost (Hemabate) - contraindicated in asthma

Misoprostol (Cytotec) PR or PO

Assess for retained tissue.

Maintain IV fluids/blood products.

Monitor vitals, urine output, and fundal tone frequently.

Empty bladder.

Signs of deterioration:

HR > 110 bpm, drop in BP, narrow pulse pressure, confusion.

Gestational diabetes. Major goals in pregnancy: What could this lead to? How to avoid complications?

Pathophysiology:

Glucose intolerance first recognized during pregnancy due to placental hormones that create insulin resistance (human placental lactogen, progesterone). (Perry et al., Ch. 27)

Major Goals:

Maintain maternal euglycemia (< 95 mg/dL fasting; < 120 mg/dL 2 hr postprandial).

Prevent neonatal hypoglycemia, macrosomia, and birth trauma.

Potential Complications:

Maternal: Preeclampsia, infections, cesarean delivery risk.

Fetal: Macrosomia, hypoglycemia, RDS, congenital defects, stillbirth.

Nursing Interventions:

Diet & exercise as first-line therapy.

Home glucose monitoring 4× daily.

Insulin if diet alone insufficient (oral hypoglycemics rarely first-line).

Fetal surveillance: NSTs, BPPs after 32 weeks.

Postpartum: Recheck glucose at 6-12 weeks for type 2 DM development.

Normal development interventions for newborns. Think, NICU, preemies, etc.

At‑risk infants: Premature (< 37 weeks), low birth weight, or medically fragile (Perry et al., Ch. 31-32)

Common interventions:

Thermoregulation: Maintain neutral thermal environment, incubator use, skin‑to‑skin (kangaroo care).

Respiratory support: Continuous pulse oximetry, CPAP, surfactant therapy.

Nutritional support: IV fluids/TPN until ready for oral or gavage feeds.

Infection control: Strict hand hygiene, asepsis.

Family‑centered care: Encourage parental presence, teach cue‑based feeding and bonding.

Developmental care:

Cluster care to limit stress.

Soft lighting and noise control.

Gentle containment and positioning that mimics in‑utero flexion

Placental abruption. Signs and symptoms?

Definition:

Premature separation of a normally implanted placenta after 20 weeks of gestation → hemorrhage between placenta and uterine wall. (Perry et al., Ch. 25)

Types: Mild (grade 1), Moderate (grade 2), Severe (grade 3).

Signs & Symptoms:

Painful dark red vaginal bleeding

Rigid, boardlike abdomen

Uterine tenderness

Rapid uterine contractions

Signs of shock disproportionate to visible loss

Fetal distress → late decelerations or bradycardia

Priority Interventions:

Assess maternal/fetal status (EFM, VS, fundal tone).

IV fluids & O₂.

Type & crossmatch; prepare for blood products.

NO vaginal exams!

C‑section often indicated if fetus viable.

Antibiotic risks for newborns! What parts of the body can these drugs affect?

Organs affected:

Ears (ototoxicity): e.g., aminoglycosides → hearing loss, vestibular damage.

Kidneys (nephrotoxicity): impaired renal function, especially with aminoglycosides.

GI tract: altered flora → diarrhea, candidiasis (thrush, diaper rash).

Liver: some antibiotics can affect hepatic function.

Blood: risk of kernicterus with certain sulfonamides (displace bilirubin).

Adolescent behaviors, specifically r/t health and healthcare.

Common patterns:

Risk-taking: substance use, unsafe sex, poor diet, nonadherence to meds.

Body image focus: eating disorders, over-exercising, or neglecting health.

Peer influence > parents: peers strongly affect health choices.

Privacy/autonomy needs: may avoid care if confidentiality not assured.

Concrete teaching: short, honest, nonjudgmental explanations; involve them in decisions.

Epidurals. What are priority assessments? What can they lead to in the mother?

Priority assessments:

Before/ongoing:

Maternal BP & HR: watch for hypotension.

Fetal heart rate (FHR).

Level of block: dermatomes, motor strength, ability to move legs.

Bladder status: urinary retention.

Respiratory status & LOC if high block suspected.

What can they lead to in the mother?

Maternal hypotension → fetal distress.

Urinary retention.

Prolonged second stage (↓ urge to push).

Pruritus, nausea.

Spinal headache (if dural puncture).

Rare: respiratory depression, high spinal, infection, hematoma.

Variable decelerations. Priority interventions!

Priority: relieve cord compression.

Reposition: side‑lying, knee‑chest, hands‑and‑knees.

Discontinue oxytocin.

Oxygen via nonrebreather 8–10 L/min.

IV fluid bolus.

Amnioinfusion if ordered (for recurrent variables with oligohydramnios).

Notify provider; prepare for operative birth if persistent/worsening.

Shoulder dystocia! What are the priority nursing interventions during labor if this occurs?

Call for help immediately.

McRoberts maneuver: hyperflex maternal thighs to abdomen.

Suprapubic pressure: NEVER fundal pressure.

Assist with position changes: Gaskin (hands‑and‑knees) if ordered.

Document times (head delivery, body delivery).

After birth: assess newborn for clavicle fracture, brachial plexus injury; assess mother for PPH, lacerations.

Insulin education, specifically for aging children.

Key points:

Rotate injection sites within same region to avoid lipodystrophy.

Match insulin to meals/snacks; never skip insulin with carbs.

Recognize hypo vs hyperglycemia and how to treat hypoglycemia (fast-acting carbs).

Involve child in self-care (age-appropriate: checking BG, drawing up insulin).

Sick-day rules: never stop insulin, monitor BG/ketones more frequently, maintain fluids.

School plan: snacks, glucagon availability, activity adjustments.

Hemophilia. Appropriate coping mechanisms for children?

Coping & psychosocial:

Age-appropriate education about condition and safety.

Encourage safe physical activity (swimming, walking) to avoid isolation.

Involve child in treatment (e.g., factor infusions as they get older).

Support groups/camps for children with bleeding disorders.

Teach family to manage anxiety around bleeds and to use RICE and factor promptly.

Significant risks for DIC in pregnancy.

Obstetric triggers:

Placental abruption.

Severe preeclampsia/HELLP.

Amniotic fluid embolism.

Intrauterine fetal demise retained.

Sepsis.

Massive hemorrhage, trauma.

Septic abortion.

Rupture of membranes. Priority assessments.

First priorities:

Fetal heart rate (rule out cord prolapse).

Color/odor/amount of fluid: clear vs meconium vs foul (infection).

Time of rupture: prolonged ROM ↑ infection risk (>18 hr).

Maternal temperature & VS (infection).

Presentation & station if concern for cord prolapse.

Pediatric vital signs

HR: highest in newborns, gradually decreases with age.

Newborn: ~110–160.

Toddler: ~90–140.

School-age: ~75–118.

RR: highest in infants, decreases with age.

Newborn: ~30–60.

Toddler: ~24–40.

School-age: ~18–30.

BP: lowest in infants, increases with age.

Know that hypotension in kids is late and ominous.

Cast care, clubfoot, and priority assessments (the 5 Ps).

5 Ps (neurovascular checks):

Pain (especially disproportionate).

Pallor.

Pulselessness.

Paresthesia.

Paralysis.

Cast care:

Elevate extremity, ice first 24–48 hr.

Check 5 Ps frequently.

Keep cast dry, no objects inside.

Teach to report increasing pain, swelling, odor, hot spots.

Clubfoot (Ponseti casting):

Serial casting started early.

Frequent skin checks under edges.

Parental teaching about cast care and follow-up.

Contraindications to vaccines, live vaccines, and autoimmune conditions.

Live vaccines: MMR, varicella, live attenuated influenza (nasal), rotavirus.

Absolute contraindications:

Severe anaphylactic reaction to previous dose or component (e.g., neomycin, egg for some).

Severe immunodeficiency for live vaccines (e.g., chemo, severe HIV).

Pregnancy for live vaccines.

Precautions with autoimmune conditions:

Inactivated vaccines generally safe.

Live vaccines may be avoided if on high-dose immunosuppressants.

Always check current guidelines and meds (steroids, biologics).

Toddler development and milestones

Age: 1–3 years.

Physical/motor:

Walks independently, then runs, climbs stairs with help, later with alternating feet.

Fine motor: builds tower of blocks, scribbles, uses spoon, begins to undress self.

Cognitive/language:

Egocentric thinking.

Vocabulary explodes: 2-word phrases by ~2 years, follows simple commands.

Parallel play (next to, not with, other kids).

Psychosocial:

Autonomy vs shame/doubt: wants to do things independently.

Rituals and routines very important.

Temper tantrums common—limit setting, choices, consistency.

Safety: high risk for injury—curiosity + mobility.

What is the PRIORITY of all assessments for a brand-new newborn? (-->Fetal demise?!)

Immediate priorities (think ABC + thermoregulation):

Airway: clear, effective respirations, no severe retractions.

Breathing: RR, effort, color.

Circulation: HR, color, perfusion.

Temperature: dry, warm (prevent cold stress).

Apgar at 1 and 5 minutes.

Check for gross anomalies and cord vessels.

Fetal demise context: confirm presence/absence of heart rate and respirations first.

Necrotizing enterocolitis (NEC). Know everything. Which population is most at risk? Assessments, interventions, signs/symptoms?

Most at risk: premature infants, especially very low birth weight, formula-fed, and those with intestinal ischemia or infection.

Signs/symptoms:

Feeding intolerance, increased gastric residuals.

Abdominal distention, tenderness.

Bloody stools.

Lethargy, temperature instability, apnea, and bradycardia.

Pneumatosis intestinalis on x-ray (air in bowel wall).

Interventions:

Stop enteral feeds; NPO.

NG decompression.

IV fluids, TPN.

Broad-spectrum antibiotics.

Frequent abdominal girth checks, VS.

Surgery if perforation or necrosis.

Pyelonephritis! Everything. Signs, symptoms, risks, treatments, etc.

What it is: infection of the kidney (upper UTI).

Signs/symptoms:

Fever, chills.

Flank or back pain, CVA tenderness.

Nausea/vomiting.

Dysuria, frequency, urgency (may or may not be present).

Risks:

Untreated lower UTI.

Vesicoureteral reflux.

Pregnancy.

Obstruction, stones.

Treatment:

Antibiotics (often IV initially).

Fluids, pain control.

Monitor for sepsis.

Teach to complete antibiotics, prevent recurrence (hydration, voiding habits).

ADHD. Study proper education for this condition

Medication teaching:

Stimulants: give in morning; can ↓ appetite and cause insomnia.

Monitor weight, growth, BP, HR.

Avoid late-day doses.

Behavioral strategies:

Structured routines, clear rules.

Break tasks into small steps.

Positive reinforcement.

School:

IEP/504 plans, quiet environment, extra time, and seating near the teacher.

Major signs of respiratory distress, think child respiratory conditions.

Tachypnea.

Nasal flaring.

Retractions (subcostal, intercostal, suprasternal).

Grunting.

Head bobbing (infants).

Stridor, wheezing.

Cyanosis, poor feeding, lethargy.

Any decreased respiratory effort after severe distress is ominous.

Tetralogy of Fallot. What can this lead to? What can exacerbate this condition? How to treat?

What it is: 4 defects—VSD, pulmonary stenosis, overriding aorta, right ventricular hypertrophy.

What it can lead to:

Cyanosis, “tet spells” (hypercyanotic episodes).

Clubbing, polycythemia.

Growth failure, exercise intolerance.

What exacerbates it:

Crying, feeding, exertion, stress.

Dehydration (↑ viscosity).

Treatment:

During tet spell: knee‑chest position, oxygen, morphine, calm environment.

Long-term: surgical repair; maintain hydration; monitor for anemia/polycythemia

RSV. Know signs, symptoms, treatments, and outcomes.

What it is: viral infection causing bronchiolitis, especially in infants.

Signs/symptoms:

Runny nose, cough, low-grade fever.

Wheezing, crackles, tachypnea.

Retractions, nasal flaring, poor feeding, apnea (especially in young infants).

Treatment:

Supportive: oxygen, suctioning, hydration.

Possible hospitalization for severe distress or high-risk infants.

Prevention: palivizumab for high-risk infants (premature, CHD, chronic lung disease).

Juvenile arthritis. Priority care teachings/interventions.

Goals: control pain, preserve joint function, promote growth and development.

Interventions:

NSAIDs, DMARDs, biologics as prescribed.

Regular exercise and PT, swimming is great.

Warm baths, heat packs for stiffness.

Splints to maintain alignment.

Encourage school attendance and normal activities with accommodations.

Rheumatic fever. Study what causes this, what it can lead to.

Cause: autoimmune response to untreated or inadequately treated group A strep pharyngitis.

What it can lead to:

Rheumatic heart disease (valvular damage, especially mitral).

Polyarthritis, chorea, subcutaneous nodules, erythema marginatum.

Key teaching:

Complete all antibiotics for strep throat.

Long-term prophylactic antibiotics to prevent recurrence.

VSD (ventricular septal defect). What is it? What can it lead to? What are priority treatments/interventions and their side effects?

What it is: opening between right and left ventricles.

What it can lead to:

Left-to-right shunt → pulmonary overcirculation.

Heart failure, poor feeding, failure to thrive.

Pulmonary hypertension if untreated.

Priority treatments/interventions:

Monitor for HF: tachypnea, poor feeding, diaphoresis.

Medications: diuretics, ACE inhibitors, sometimes digoxin.

High-calorie feeds.

Surgical or catheter closure if significant.

Side effects to watch:

Diuretics: dehydration, electrolyte imbalance.

ACE inhibitors: hypotension, cough, hyperkalemia.

Digoxin: bradycardia, toxicity (vomiting, arrhythmias).

Know all about spina bifida, what it can lead to, patient care/safety, and interventions

Types: occulta, meningocele, myelomeningocele (most severe).

What it can lead to:

Motor and sensory deficits below lesion.

Neurogenic bladder/bowel.

Hydrocephalus (often with Chiari II).

Orthopedic deformities.

Patient care/safety (pre-op myelomeningocele):

Protect sac: sterile, moist, nonadherent dressing; prone position; no pressure on sac.

Strict infection prevention.

Monitor for CSF leak.

Head circumference, signs of ↑ ICP.

Long-term:

Bladder/bowel programs.

Skin care, mobility aids.

Latex precautions (high risk of latex allergy).

That segways into alph-feto protien. What happens if it's high and low?

High AFP (maternal serum):

Open neural tube defects (e.g., spina bifida, anencephaly).

Abdominal wall defects.

Wrong dates (further along than thought).

Low AFP:

Chromosomal abnormalities (e.g., Down syndrome).

Wrong dates (earlier than thought).

Always interpreted with other markers and ultrasound.

Know your med dosage calculations! Specifically, oxytocin calcs and mg/kg/day.

Oxytocin:

Usually ordered in milliunits/min.

You’ll convert from mU/min → mL/hr based on concentration (e.g., 30 units in 500 mL).

Formula:

mL/hr=ordered mU/min×60mU per mL in bag

mg/kg/day:

Step 1: find total daily dose:

mg/day=mg/kg/day×weight (kg)

Step 2: divide by number of doses per day to get mg per dose.

Practice a few problems until it feels automatic.

Know about a cleft lip. How would you care for the infant?

Feeding:

Upright position, slow feeds.

Special nipples (Haberman, longer nipples, squeezable bottles).

Frequent burping (swallow more air).

Post-op care:

Protect suture line: no prone, no hard objects in mouth.

Use elbow restraints as ordered.

Clean suture line gently with prescribed solution.

Pain control to prevent crying and tension on repair.

Biliary atresia. This one is tough. Study some non-surgical interventions.

What it is: obstruction/absence of bile ducts → cholestasis, liver damage.

Non-surgical care:

Nutritional support: high-calorie, medium-chain triglycerides, fat-soluble vitamin supplements (A, D, E, K).

Manage pruritus: meds as ordered, skin care, short nails.

Monitor growth, I&O, stool/urine color.

Prepare family for possible Kasai procedure and eventual transplant.

Inguinal hernias/hypospadias. What are the normal findings with this condition?

Inguinal hernia:

Soft bulge in groin or scrotum, more obvious with crying/straining.

Reducible (can be gently pushed back) if not incarcerated.

Hypospadias:

Urethral opening on ventral (underside) of penis.

Chordee (curvature) may be present.

Normal finding: no circumcision before repair (foreskin used in surgery).

Study nephrotic syndrome and priority teachings/interventions if someone has this autoimmune condition

What it is: autoimmune glomerular disease → massive proteinuria, hypoalbuminemia, edema, hyperlipidemia.

Priority teachings/interventions:

Monitor edema, daily weights, I&O.

Salt restriction during edema; sometimes fluid restriction.

Corticosteroids are mainstay; teach about side effects (infection risk, weight gain).

Skin care for edema, elevate edematous areas.

Prevent infection (loss of immunoglobulins in urine).

Herpes infections in pregnancy. Would would this lead to? What would labor look like?

Risk: neonatal herpes if exposed to active lesions during vaginal birth.

What it can lead to:

Severe neonatal infection (skin, eye, mouth, CNS, disseminated).

Labor management:

Active genital lesions or prodromal symptoms: C-section recommended.

No lesions: vaginal birth usually allowed; often on suppressive antivirals in late pregnancy.

Study impetigo. How would you care for this condition? (Think, it's a staph/strep infection with lesions!!)

Cause: staph or strep; honey-colored crusted lesions.

Care:

Topical antibiotics (e.g., mupirocin); oral antibiotics if extensive.

Gently wash crusts with soap and water before applying ointment.

Keep nails short; avoid scratching.

No sharing towels, linens; wash in hot water.

Child may be excluded from daycare/school until 24 hr after starting antibiotics (per policy).

Study congenital hypothyroidism. Why does this occur? What does it look like? Diagnostic findings.

Why it occurs: absent or underdeveloped thyroid gland, or defects in hormone synthesis.

What it looks like (often subtle early):

Prolonged jaundice.

Lethargy, poor feeding.

Constipation.

Large fontanels, macroglossia, hypotonia.

Later: growth delay, developmental delay if untreated.

Diagnostics:

Newborn screening: elevated TSH, low T4.

Confirmatory thyroid function tests.

Treatment: lifelong levothyroxine; stress importance of adherence.

Priority prevention/interventions for Otitis Media.

Prevention:

Breastfeeding (protective).

Avoid bottle propping and supine feeding.

No secondhand smoke.

Vaccines: pneumococcal, influenza.

Interventions:

Pain control: acetaminophen/ibuprofen (age-appropriate).

Antibiotics if indicated (age, severity, bilateral vs unilateral).

Teach to complete antibiotics.

Tympanostomy tubes for recurrent cases; keep water out per provider instructions.

Normal hemo/hemat levels during the different semesters of pregnancy. What is going on in the cardiovascular system?

Hemodilution: plasma volume ↑ more than RBC mass → physiologic anemia of pregnancy.

Typical ranges (approximate):

Nonpregnant Hgb: ~12–16 g/dL.

Pregnancy: Hgb often ~11–12 g/dL; <11 often considered anemic (trimester-specific ranges vary).

CV changes:

↑ Blood volume, ↑ cardiac output.

↓ SVR → slight ↓ BP in 2nd trimester, returns near baseline in 3rd.

↑ HR by ~10–15 bpm.

When an infant needs a blood draw, what would that look like?

Common methods:

Heel stick for newborn screening, small labs.

Venipuncture (hand, antecubital, scalp veins) for larger volumes.

Nursing considerations:

Warm heel before stick to increase blood flow.

Use appropriate lancet depth to avoid bone injury.

Comfort measures: swaddling, sucrose, breastfeeding, nonnutritive sucking.

Label carefully and minimize blood loss

Breastfeeding. Study what that looks like immediately postpartum.

Initiate within first hour if stable.

Skin-to-skin contact to promote bonding and thermoregulation.

Positioning and latch: nose to nipple, wide mouth, more areola in mouth.

Feed on demand, at least 8–12 times/24 hr.

Teach normal patterns: colostrum first, then transitional milk; cluster feeding is normal.

Study medications given to the infant immediately after birth. "Big 3" What do they do/prevent/provide?

Vitamin K (IM): prevent hemorrhagic disease of the newborn.

Erythromycin ophthalmic ointment: prevent ophthalmia neonatorum (gonorrhea/chlamydia).

Hepatitis B vaccine: start immunization series; sometimes with HBIG if mom is HBsAg+.

What are the most concerning vitals for a pregnant patient? Like, what would be the most dangerous?

Red flags:

Severe hypertension: ≥160/110 → risk of stroke, eclampsia, placental abruption.

Tachycardia with hypotension: suggests hemorrhage (e.g., ectopic, abruption, PPH).

Fever: ≥38°C (100.4°F) with tachycardia → infection (chorioamnionitis, sepsis).

Tachypnea or dyspnea, low O2 sat: PE, pulmonary edema, severe anemia.

Always interpret vitals with gestational age and symptoms.

Alcohol in pregnancy. What should we teach about this?

No safe amount, no safe time, no safe type.

Risks:

Fetal alcohol spectrum disorders: growth restriction, facial anomalies, neurodevelopmental problems.

Miscarriage, stillbirth, preterm birth.

Teaching:

Complete abstinence during pregnancy and while trying to conceive.

Screen gently and nonjudgmentally.

Offer resources for cessation and support.